HOUSE BILL No. 6392 September 24, 2002, Introduced by Reps. Schauer, Lemmons, McConico, Durhal, Gieleghem, Woodward, Mans, O'Neil, Jacobs, Wojno, Bernero, Rich Brown, Adamini and Neumann and referred to the Committee on Insurance and Financial Services. A bill to protect and promote children's health; to create the MIChild program; to prescribe the powers and duties of the department of community health; and to prescribe certain duties of certain other state departments, officers, and agencies. THE PEOPLE OF THE STATE OF MICHIGAN ENACT: 1 Sec. 1. This act shall be known and may be cited as the 2 "Michigan's families health care act". 3 Sec. 2. As used in this act: 4 (a) "Dental care corporation", "health care corporation", 5 "insurer", and "prudent purchaser agreement" mean those terms as 6 defined in section 2 of the prudent purchaser act, 1984 PA 233, 7 MCL 550.52. 8 (b) "Department" means the department of community health. 9 (c) "Entity" means a health care corporation or insurer 10 operating in accordance with a prudent purchaser agreement. 05014'01 LTB 2 1 (d) "Federal poverty guidelines" means the poverty 2 guidelines updated annually in the federal register by the United 3 States department of health and human services under authority of 4 42 U.S.C. 9902(2). 5 (e) "MIChild program" means the program created in 6 section 3. 7 Sec. 3. (1) The department shall establish and administer 8 the MIChild program to provide comprehensive health care coverage 9 to all children less than 19 years of age who reside in families 10 with income at or below 200% of the federal poverty guidelines, 11 who are uninsured and have not had coverage by other comprehen- 12 sive health insurance within 6 months of making application for 13 MIChild benefits, and who are residents of this state. The 14 department shall develop detailed eligibility criteria through 15 the medical services administration public concurrence process, 16 consistent with this act. Health care coverage for children in 17 families below 150% of the federal poverty level shall be pro- 18 vided through expanded eligibility under the state's medicaid 19 program. Health coverage for children in families between 150% 20 and 200% of the federal poverty guidelines shall be provided 21 through a state-based private health care program. 22 (2) The department shall provide comprehensive health care 23 coverage to parents of children meeting the eligibility criteria 24 established under this act. Parents of children meeting the eli- 25 gibility criteria are not required to complete an application for 26 coverage other than the application submitted for the eligible 27 child. 05014'01 3 1 Sec. 5. (1) The department shall enter into a contract to 2 obtain MIChild services from any HMO, dental care corporation, or 3 any other entity that offers to provide the managed health care 4 benefits for MIChild services at the MIChild capitated rate. 5 (2) The department may enter into contracts to obtain cer- 6 tain MIChild services from community mental health service 7 programs. 8 (3) The department may make payments on behalf of children 9 enrolled in the MIChild program from the line-item appropriation 10 associated with the program as described in the MIChild state 11 plan approved by the United States department of health and human 12 services, or from other medical services line-item appropriations 13 providing for specific health care services. 14 Sec. 7. The department shall continue a comprehensive 15 approach to MIChild's marketing and outreach program. Marketing 16 and outreach required under this section shall be coordinated 17 with current outreach, information dissemination, and marketing 18 efforts and activities conducted by the department. 19 Sec. 9. The department may provide up to 1 year of continu- 20 ous eligibility to children eligible for the MIChild program and 21 their parents unless the status of the children's family changes 22 and the family members no longer meet the eligibility criteria as 23 specified in the federally approved MIChild state plan. 24 Sec. 11. (1) The department may establish premiums for 25 MIChild eligible persons in families with income above 150% of 26 the federal poverty guidelines. The monthly premiums shall not 27 exceed $5.00 for a family. 05014'01 4 1 (2) The department shall not require copayments under the 2 MIChild program. 3 Sec. 13. Children whose category of eligibility changes 4 between the medicaid and MIChild programs are allowed to keep 5 their current health care providers through the current pre- 6 scribed course of treatment for up to 1 year, subject to periodic 7 reviews by the department if the beneficiary has a serious medi- 8 cal condition and is undergoing active treatment for that 9 condition. 10 Sec. 15. To be eligible for the MIChild program, a child 11 must reside in a family with an adjusted gross income of less 12 than or equal to 200% of the federal poverty guidelines. The 13 department's verification policy shall be used to determine 14 eligibility. 15 Sec. 17. The MIChild program shall provide all benefits 16 available under the state employee insurance plan that are deliv- 17 ered through the medicaid HMOs and consistent with federal law, 18 including, but not limited to, all of the following medically 19 necessary services: 20 (a) Inpatient mental health services, other than substance 21 abuse treatment services, including services furnished in a 22 state-operated mental hospital and residential or other 24-hour 23 therapeutically planned structured services. 24 (b) Outpatient mental health services, other than substance 25 abuse services, including services furnished in a state-operated 26 mental hospital and community-based services. 05014'01 5 1 (c) Durable medical equipment and prosthetic and orthotic 2 devices. 3 (d) Dental services as outlined in the approved MIChild 4 state plan. 5 (e) Substance abuse treatment services that may include 6 inpatient, outpatient, and residential substance abuse treatment 7 services. 8 (f) Care management services for mental health diagnoses. 9 (g) Physical therapy, occupational therapy, and services for 10 individuals with speech, hearing, and language disorders. 11 (h) Emergency ambulance services. 12 Sec. 19. The department shall explore options under the 13 federal state children's health insurance program (SCHIP), 14 including waiver requests, to extend coverage to low-income par- 15 ents of MIChild eligible children. The department may also 16 explore options to increase the medicaid income disregard for 17 parents of medicaid or MIChild eligible children who have income 18 up to 100% of the federal poverty guidelines. The department 19 shall issue a report that identifies the estimated number of per- 20 sons to be served and the projected costs for the various health 21 care coverage options considered to the house and senate appro- 22 priations subcommittees on community health and the house and 23 senate fiscal agencies by March 1, 2003. 05014'01 Final page. LTB